Regarding breast engorgement; All the following are true EXCEPT

Correct Answer: D

Rationale: Breast engorgement is a common issue for breastfeeding mothers, especially in the early stages of lactation. The correct answer, option D, states that breasts should NOT be softened prior to infant feeding. This is because softening the breasts before feeding can make it harder for the infant to latch properly and effectively remove milk, potentially exacerbating engorgement. Option A is true because breast engorgement typically occurs in the first stage of lactogenesis when the milk supply is increasing. Option B is also true as poor breastfeeding technique, such as improper latching or infrequent feeding, can lead to engorgement. Option C is true as breastfeeding on demand and in response to infant hunger cues can help prevent or alleviate engorgement by ensuring frequent and effective milk removal. Educationally, it is important for nursing students preparing for the NCLEX exam to understand the management of breastfeeding issues like engorgement. Knowing the correct strategies to prevent and address engorgement can help promote successful breastfeeding and support the health of both mother and baby. Understanding the nuances of breastfeeding can also help nurses provide effective education and support to breastfeeding mothers in clinical practice.

Correct Answer: D

Rationale: In malnutrition, the outward sign of cell damage is wasting (Option D). Wasting refers to the severe loss of muscle and fat tissue due to inadequate nutrient intake. This is a characteristic feature of protein-energy malnutrition. Option A, edema, is the accumulation of fluid in tissues and occurs in conditions like kwashiorkor, which is a form of severe acute malnutrition characterized by edema. However, edema is not the primary outward sign of cell damage in malnutrition. Option B, hepatomegaly, refers to an enlarged liver and can be seen in conditions like liver disease or infection. While liver damage can occur in malnutrition, hepatomegaly is not the most prominent outward sign of cell damage in this context. Option C, facial appearance, can be affected in malnutrition, leading to a gaunt or sunken appearance. However, this is more of a general physical manifestation and not a direct sign of cell damage. Understanding these distinctions is crucial in pediatric nursing practice, especially when assessing and managing malnourished children. Recognizing wasting as a sign of severe malnutrition can prompt timely interventions to address nutritional deficiencies and prevent further complications.

Correct Answer: D

Rationale: In pediatric malnutrition, particularly during the stabilization phase, providing essential trace elements is crucial for the recovery and overall health of the child. In this context, the correct answer is D) zinc. Zinc plays a vital role in immune function, wound healing, and growth, making it essential during the stabilization phase of malnutrition. Zinc deficiency is common in malnourished children, and supplementing it helps in reversing growth stunting, immune system impairment, and other complications associated with malnutrition. Now, let's discuss why the other options are incorrect: A) Iron: While iron is important for red blood cell formation, it is not typically a priority during the stabilization phase of malnutrition unless the child has been diagnosed with iron deficiency anemia. B) Vitamin A: Although vitamin A is crucial for vision, immune function, and cell growth, it is not a trace element and is usually supplemented during the rehabilitation phase of malnutrition. C) Folate: Folate is a B-vitamin necessary for cell division and growth, but it is not typically prioritized during the stabilization phase of malnutrition compared to zinc. Educational Context: Understanding the specific nutritional needs of malnourished children is essential for healthcare providers, especially those preparing for exams like the NCLEX. Knowing which trace elements are crucial during different phases of malnutrition can help in providing targeted interventions and improving patient outcomes. Mastery of this knowledge ensures safe and effective pediatric care, making it a vital concept for nursing students and professionals to grasp.

Correct Answer: A

Rationale: In refeeding syndrome, when a malnourished individual undergoes rapid refeeding, there is a shift from fat to carbohydrate metabolism, leading to increased insulin secretion and subsequent intracellular uptake of electrolytes. This shift can result in hypophosphatemia, which is the main cause of thrombocytopenia in refeeding syndrome. Option A, hypophosphatemia, is correct because low serum phosphate levels can lead to impaired platelet function and decreased platelet count, causing thrombocytopenia in refeeding syndrome. Option B, hypokalemia, is incorrect because while electrolyte imbalances like hypokalemia can occur in refeeding syndrome, they are not the primary cause of thrombocytopenia in this condition. Option C, hypomagnesemia, is incorrect as well. Although magnesium deficiency can contribute to cardiac arrhythmias in refeeding syndrome, it is not the main factor leading to thrombocytopenia. Option D, thiamine deficiency, is also incorrect. Thiamine deficiency can result in Wernicke's encephalopathy in malnourished individuals, but it is not directly linked to thrombocytopenia in refeeding syndrome. Understanding the pathophysiology of refeeding syndrome and its impact on electrolyte balance and organ function is crucial for nurses and healthcare providers caring for malnourished pediatric patients. Recognizing the role of hypophosphatemia in thrombocytopenia can guide appropriate monitoring and treatment strategies to prevent complications in these vulnerable populations.

Correct Answer: C

Rationale: The most likely diagnosis for this case is C) Hepatic abscess. Hepatic abscess presents with right upper quadrant pain, fever, hepatomegaly, and often a history of recent abdominal illness or travel to endemic areas. In this case, the patient's symptoms, physical exam findings, and recent travel to Mexico align with a hepatic abscess diagnosis, especially given the history of receiving over-the-counter medication for gastrointestinal symptoms. A) Giardiasis is less likely in this case as it typically presents with diarrhea, bloating, and flatulence, not with the symptoms described in the scenario. B) Hepatitis would typically present with jaundice, which is not present in this patient, making it a less likely diagnosis. D) Cholangitis usually presents with right upper quadrant pain, fever, and jaundice, which are not all present in this case. Educationally, this question highlights the importance of considering travel history, medication use, and specific symptomatology in diagnosing gastrointestinal conditions. It also emphasizes the need for a thorough understanding of different pathologies that can present with similar symptoms to make accurate differential diagnoses in clinical practice.